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APPLICATION FOR SANITATION PERMIT Permit No. .. E?-''-_ (Complete in Duplicate) ff Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 JOB ADDRESS AND LOCATION___________ ____1_---2---4e--__ ,� �� - /p --- ----- ... ... --------- Owner's Name-------- v4 - --------- /-------- ------- ---------- Phone Address-----------------_-- �f__ .------- ------ ----------..---------------------------------------------------- ---------- Contractor's Name------ __-_ -_ ------------ S' - Phone Installation will serve.- Resid nce Apartment House ommercial ❑ Trailer Court ❑ Motel E] Other ❑ / Number of living units: _ _--_ N er of bedrooms --/Number Number of baths __-_ _ Lot size ------ ------>-c-____2,s _ _._ Water Supply: Public system Community system ❑ Private [] Depth to Water Table _Qft. Character of soil to a dep+h of 3 feet:' Sand ❑ Gravel E] Sandy Loam E] Clay Loam E] Clay [] Adobe �ardpan [:I— Previous Application Made. Yes ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [�' i TYPE OF INSTALLATION AND SPECIFICATIONS: e 4-7 -(No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Se is Tan : J Distance from nearest well_________________Distance from foundation--------.-----------Material--_,_-______-_.._______--___.______....____ ® No. of compartments---------------- Size------------------•-=----------Liquid dept--------------------------Capacity---------------------- � Aa osal' ie�f:. Distance from nearest well---K.._._._-_Distance from foundation_____'____-_Distance to nearest lot line__--�r_, p ._____-__ --- ----Length of each line___.___ ___--____ .Width of trenchcZ Number l lines - �- 0000 0t f j Total length-.--j--,Z) Type of filter material___ c -__Qepth of filter material____- Seepage Pit: Distance to near well__ _ _ -_______Distant rom foundation_____/p..__..Distance' to.nearest lot line- �_ _' Number of pits._.__---------------Lining material__ _ ___.___Size: Diameter___ �f___.Depth_ ._ __! Cesspool: Distance from nearest well--------------___Distance from'oundation--------------------Lining material------------------------------------- Size- ____-_...___..__---________________Size- Diameter-------------- ------------Depth---------------- -----------------------------------Liquid Capacity----------------------------gals. � Privy: -Distance from nearest well------____________________________---------___Distance from nearest building------------------------------'-_--__-_--- ❑ Distance to nearest lot line------------------- f Remodeling and/or repairing (describe)------------------------------------------------------------------------------------ ------------•-------------------- ----------- I hereby certify that 1-have prepared this application and that the work will be•done in accordance with San Joaquin County ces, S+a+e. and regulations of the San Joaquin Local Health District. or ma 9M-Z OH opu'0P13 •oS 90Z i. e4 (Signed-- ;�►sa a• sa d- ` I--- - Contractor) S- � 1 � � -----0000-- 0 000-------0000-- 0000- - ��- By:-------------R%K_'g AV_Q----_----------- ✓(_(Ti+le)-- ---- - --00.0.0 - ----------------0000-- � s t/ p (Piot plan, showing size of lot, location of system in relation tow Is, building s, e+ ., can be laced an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY •-}----------- ------------------------------------------------ DATE REVIEWED BY -- -- - --- DATE---._:—,_-- :�- BUILDING PERMIT ISSUED------------------ -�- l*_________--- _--,- ,• �-� ----------------- DATE--------'---------- Alterat.ions and/or recommendations:__. ✓,, yr t��i ._--_-----114 "" If_4 .�.f_--------------------------------^ - _0000 - H0000----�,•dT y ------- -- 0000--__- --------------- ----------^----"----'--------'------e---------------------------•---------------`----------------------------------•---------------------------------------------------------------------------------------------------- .+. FINAL rINSPECTION BY:.__�_- -.2-_-�--------- ------ - Date--- _�_ y SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Street S+ockto», California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO.